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Selective Serotonin Reuptake Inhibitors and Intracerebral Hemorrhage Risk and Outcome.

Publication ,  Journal Article
Liu, L; Fuller, M; Behymer, TP; Ng, Y; Christianson, T; Shah, S; King, NKK; Woo, D; James, ML
Published in: Stroke
April 2020

Background and Purpose- Selective serotonin reuptake inhibitors (SSRIs) have a well-established association with bleeding complications and conflicting reports on outcome after stroke. We sought to evaluate whether pre-intracerebral hemorrhage (ICH) SSRI use increased ICH risk and post-ICH SSRI use improved ICH outcome. Methods- Through post hoc analysis of the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage), SSRI use was categorized into no use, pre-ICH only, pre- and post-ICH use (termed "continuous"), and post-ICH only (termed "new"). Using multivariable modeling, associations were sought between pre-ICH SSRI use and ICH risk in the case-control set, and associations between post-ICH SSRI use and 3-month outcome were analyzed in the ICH case set. Exploratory analyses sought to assess influence of race/ethnicity in models. Results- The final study cohort consisted of 2287 ICH cases and 2895 controls. Pre-ICH SSRI use was not associated with ICH risk (odds ratio, 0.824 [95% CI, 0.632-1.074]) nor potentiation of ICH risk with anticoagulant or antiplatelet use. New post-ICH SSRI use was associated with unfavorable modified Rankin Scale score at 3 months after ICH (odds ratio, 1.673 [95% CI, 1.162-2.408]; P=0.006) in multivariable analyses. Additional propensity score analysis indicated a similar trend but did not reach statistical significance (P=0.107). When stratified by race/ethnicity, multivariable modeling demonstrated reduced ICH risk with pre-ICH SSRI use in Hispanics (odds ratio, 0.513 [95% CI, 0.301-0.875]; P=0.014), but not non-Hispanic whites or blacks, and no associations between post-ICH SSRI use and 3-month outcome in any racial/ethnic group. Conclusions- In a large multiethnic cohort, pre-ICH SSRI use was not associated with increased ICH risk, but post-ICH SSRI use was associated with unfavorable 3-month neurological outcome after ICH. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01202864.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

April 2020

Volume

51

Issue

4

Start / End Page

1135 / 1141

Location

United States

Related Subject Headings

  • White People
  • Treatment Outcome
  • Selective Serotonin Reuptake Inhibitors
  • Risk Factors
  • Prospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Hispanic or Latino
 

Citation

APA
Chicago
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MLA
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Liu, L., Fuller, M., Behymer, T. P., Ng, Y., Christianson, T., Shah, S., … James, M. L. (2020). Selective Serotonin Reuptake Inhibitors and Intracerebral Hemorrhage Risk and Outcome. Stroke, 51(4), 1135–1141. https://doi.org/10.1161/STROKEAHA.119.028406
Liu, Li, Matthew Fuller, Tyler P. Behymer, Yisi Ng, Thomas Christianson, Shreyansh Shah, Nicolas Kon Kam King, Daniel Woo, and Michael L. James. “Selective Serotonin Reuptake Inhibitors and Intracerebral Hemorrhage Risk and Outcome.Stroke 51, no. 4 (April 2020): 1135–41. https://doi.org/10.1161/STROKEAHA.119.028406.
Liu L, Fuller M, Behymer TP, Ng Y, Christianson T, Shah S, et al. Selective Serotonin Reuptake Inhibitors and Intracerebral Hemorrhage Risk and Outcome. Stroke. 2020 Apr;51(4):1135–41.
Liu, Li, et al. “Selective Serotonin Reuptake Inhibitors and Intracerebral Hemorrhage Risk and Outcome.Stroke, vol. 51, no. 4, Apr. 2020, pp. 1135–41. Pubmed, doi:10.1161/STROKEAHA.119.028406.
Liu L, Fuller M, Behymer TP, Ng Y, Christianson T, Shah S, King NKK, Woo D, James ML. Selective Serotonin Reuptake Inhibitors and Intracerebral Hemorrhage Risk and Outcome. Stroke. 2020 Apr;51(4):1135–1141.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

April 2020

Volume

51

Issue

4

Start / End Page

1135 / 1141

Location

United States

Related Subject Headings

  • White People
  • Treatment Outcome
  • Selective Serotonin Reuptake Inhibitors
  • Risk Factors
  • Prospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Hispanic or Latino